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03/07/2005 09:11 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> Daley 31312005 4:18:04PM SAND UIN COUNTY ENVIRONMENTAL HEALIVEPARTMENT Repots ON21 <br /> RM pepel <br /> unt <br /> Facility Information as of 3/3/2005 <br /> aecaeaWgen Calerk' Feeley ID FA00/51ISt <br /> MAR 1y I AfdK Make changeslcorrectione In RED ink or pencil. <br /> INFORMATION CHANGE(dale) <br /> OWNER FILE INFORMATION <br /> OFFICE N O RUIN COUNTY <br /> OWNERSHIP CHANGE(dote) <br /> S R CES <br /> owner ID OW0012096 Case Number: H07000 NewOwnerlD <br /> Owner Name JAGUAR EXPRESS INC <br /> Owner DBA JAGUAR EXPRESS INC <br /> Owner Address 3798 S HWY 99 <br /> STOCKTON, CA 95215 V� <br /> Home Phone 209460-0877 1�/V <br /> Worklausiness Phone Not Specified / o <br /> Mailing Address PO BOX 30785 <br /> STOCKTON, CA 95213 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0015115 <br /> Facility Nome JAGUAR EXPRESS INC <br /> Location 3798 S HWY 99 <br /> STOCKTON, CA 95215 <br /> Phone 209-460-0877 <br /> Mailing Address p0 BOX 30785 <br /> STOCKTON,CA 95213 <br /> Care of APN:17917132 <br /> Location Code 99-UNINCORPORATED AREA SIC Code: <br /> BOS District 002-MARENGO, DARIO <br /> ACCOUNTS RECEIVABLE FILE INFORMATION New Account ID. <br /> Account ID AR0025918 Mail Invoices to: Owner I Facility 1 Account <br /> Mail Invoices to Owner (CNae 0—) <br /> Account Name JAGUAR EXPRESS INC <br /> Account Balance as of 3/312005: $309.00 (Cv oriel <br /> Trem le AMWA.We <br /> N—0w 0 heel. <br /> Sl.ae <br /> prcaralA�lem�eM DousClbn R.eere m Empbyee ID aria nmm. Y N A I D <br /> PR0522970 EE0008844-DINA CRAW Active <br /> 2133-CUPA Fina-CE Active Y N A Cl D <br /> 2220,SM HW GEN<5 TONSNR PRO522189 EED008844-DINA CRAW Active y N A I D <br /> 2244-PACT TRANSFER RECORD-DES PROS22824 _ <br /> _ pH5/FHO routs eAerp Mla�S�i erds.b <br /> BILLING 91MCOrAVL1ANCE ACRNOWLEDGMadmIna OWNN Ream,..,1 oleoia malts w,m. Kin a�p°nn°Re°aNx wAenc %ell eipft W Orelnaee Cea <br /> IMINty a-awy"ee 1111d Ip an pwtl" <br /> Slate 61Nler Fede"Lawn <br /> Data <br /> APPLICANT'S SIGNATURE: <br /> $20,1010= Amount Paid Data <br /> Program Records to he TRANSFERED: -f 155 00= Amount Paid Dale <br /> Wetef System to be TRANSFERED: Received by�— <br /> Payment TYPO- Date Check Number <br /> REHS: J ('v�= Account Out: Dak��l�lG9,� <br /> �_/u,-I <br /> COMMENTS. t <br /> LLrt.dCC�G'Lt40. <br /> . .s A N <br /> \\phs-ehSQI-nt\appS`envlslona\(QPOrts\5021.mnt <br />